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What US Health Care Needs
Medical doctor and writer Atul Gawande gave the commencement address recently at Stanford's School of Medicine. In it he lays out very precisely and in a nonpartisan way what is wrong with the institution of medical care in the US — why it is both so expensive and so ineffective at delivering quality care uniformly across the board. "Half a century ago, medicine was neither costly nor effective. Since then, however, science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures. Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive. And we're struggling. There is no industry in the world with 13,600 different service lines to deliver. ... And then there is the frightening federal debt we will face. By 2025, we will owe more money than our economy produces. One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem — far and away — is the soaring and seemingly unstoppable cost of health care. ... Like politics, all medicine is local. Medicine requires the successful function of systems — of people and of technologies. Among our most profound difficulties is making them work together. If I want to give my patients the best care possible, not only must I do a good job, but a whole collection of diverse components must somehow mesh effectively. ... This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do."
If I want to give my patients the best care possible ... This will take science. It will take art. It will take innovation. It will take ambition.
...it will also take the AMA not artificially restricting the number of new doctors. More than half of ostensibly qualified applicants every year are turned away. In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty. The fewer doctors we have, the more each doctor is paid. The AMA carefully guards doctor salaries. This practice can be seen over and over (and resistance to influx of doctors willing to work for cheap) in country after country (the film Salud covers this well).
/. has a typical signal-to-noise comment ratio... for those who want to doubt my claims above, calling them propaganda, etc, they are backed up by reputable sources. Paul Farmer, for instance, has written extensively about Cuba [and also happens to be the UN Envoy to Haiti and runs Harvard's School of Social Medicine at their Medical School, so he tends to be considered a reputable source] and almost never has a bad thing to say about their healthcare attitudes or outcomes. The list goes on.)
Furthermore, we need to eliminate the debt load for student doctors. You can't expect doctors to work for lower salaries (as I propose above) when they are graduating with hundred of thousands in debt. Basically we need way more medical schools (or slots in existing schools) and we need to lower their cost in exchange for a willingness to work for less money. This has the benefit of more doctors and lower cost, as well as shifting the pool of applicants to those who want to be DOCTORS and not just those who want to make MONEY or play GOLF all the time (and so on).
Cuba is a perfect example of this. They have better or equivalent health outcomes to the United States, yet they spend a fraction (read: less than 1/20th) as much per person on healthcare. They achieve these same outcomes using finnicky x-ray machines from the 1980s and out of date textbooks. They do this by having the greatest doctor-to-patient ratio of any nation, and by focusing on preventative medicine. But that's evil socialism. Insert dramatic music here. At any given time more than a third of Cuban doctors are voluntarily serving abroad (often in Africa) doing global health work. More than a third. What percentage of American doctors voluntarily serve in Africa? And they have a 98% retention rate, so any claim that this service is to "escape Cuba" is pretty well dispelled. (and just to go on the offensive for a sec, since I don't generally reply to those who reply to me, unless they actually make good points, since as you know
I am Jack's complete lack of surprise.
Is there a link, or are we just supposed to read the blurb.
Oh hell, this is slashdot, no one reads the article anyway. Never mind. Carry on.
One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference. Our deficit problem -- far and away -- is the soaring and seemingly unstoppable cost of health care.
I'll admit that my concept of our spending is probably skewed by intentionally misleading infographics and such, but this doesn't seem to jive with anything I've ever seen. Can someone explain how this is true, or point to something that does?
http://www.newyorker.com/online/blogs/newsdesk/2009/06/atul-gawande-university-of-chicago-medical-school-commencement-address.html
Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.
I'm not saying this is the entire problem, but it's a huge part of it. If you don't see the costs of your health care, you won't wisely use it. It's the same problem plaguing college tuition costs. "Oh, it's free money - either I'm getting a loan (free money!) or someone else is paying for it!". Yeah, until schools notice this and start charging $25k a year to attend because nobody cares - it's "free money".
My solution is a high deductible plan. If you can't afford it, the government picks it up for you. You pay the first $5k of your health costs out of pocket, the HDHP kicks in afterwords. If you're too poor for that, then they have government clinics for you.
1. Put old system into barrels marked "nuclear waste".
2. Throw barrels off cliff.
3. Pick working system like that from Australia or Canada.
4. Copy it.
5. Don't let the rebulocrats change anything.
6. Profit.
I'm serious, even if you choose to keep private health your premiums will go down as they now have to compete with the lowest cost alternative (public health), which is net profit for you. Another boon will be increased service from private health funds as public health sets the minimum standard for care.
Calling someone a "hater" only means you can not rationally rebut their argument.
This will take science. It will take art. It will take innovation. It will take ambition. And it will take humility. But the fantastic thing is: This is what you get to do...
This is just lovely. Go on, start innovating, spend lots of money. By no means must you look at other countries to find out why your healthcare expenditure is so high, you can look forward to your "not invented here" syndrome to keep costing you a fortune.
Who is to say where the cut-off line should be?
You could put that line almost anywhere without being unreasonable. I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?
It seems the AMA decided that the lower 50% are unfit. OK. Well, would you want one of those doctors instead of one in the top 50%? The top 50% is dangerous enough.
Half a century ago, medicine was neither costly nor effective. [...] Our job in medicine is to make sure that all of this capability is deployed, town by town, in the right way at the right time, without harm or waste of resources, for every person alive.
This is the problem in a nutshell. The notion that leads people to call for universal health care is intuitively moral: that every human being deserves the best medical care possible, even if they can't pay for it. It seems cruel to deny that. But medical care is some of the most expensive labor in the world. And justly so: pharmaceutical patent abuse aside, doctors and nurses deserve to be paid a bundle for how long they have to study to get certified and for what a general pain in the ass their job is. So to say that every human being should be provided with ample attention from doctors, at the government's expense if necessary, is akin to campaigning for a universal supply of platinum bars.
I get that the speaker isn't necessarily speaking as though socialized medicine is the only answer, but he seems to implicitly acknowledge that the government is the only one who will pay doctors to care for poor people. Even if you don't oppose such a thing on political grounds, the money just plain isn't there. I can't really suggest a solution except to keep science and technology marching along and hope that medicine eventually starts getting cheaper when the remedies we invent finally start outpacing the diseases we discover.
"This algorithm runs in constant time. Come on, 2,147,483,648 is a constant..."
Looks like the esteemed Atul Gawande was stretching it a bit when he said "One side says war spending is the problem, the other says it's the economic bailout plan. But take both away and you've made almost no difference."
Some nice wikipedia pie charts demonstrate that reducing defence spending would fix a lot:
http://en.wikipedia.org/wiki/2010_United_States_federal_budget
Then again, total defence spending is still less than Medicare + Medicaid, but also remember that the original article refers to "war spending", which is presumably only a fraction of total defence spending.
As for bailout costs: the cost of the Troubled Asset Relief Program ($154 billion in 2009) plus the American Recovery and Reinvestment Act of 2009 ($353 billion in 2010) is a total of $500 billion, while Medicare + Medicaid is $750 billion.
I reckon covering 2/3 of the budget would do a helluva lot more than make "no difference".
The Movie "The Blob" Supports the Case Against Government Healthcare
Okay, this isn't exactly the most serious piece I've ever written, but I think it's interesting and may make a good point. This past Spring, I was sifting through Comcast OnDemand, and found two versions of the movie "The Blob"- the original 1958 version, and the 1988 remake. The 1958 version is an old favorite of mine, so I decided to check out the 1988 version for comparitive purposes. I didn't get very far into the movie- I thought it was awful compared to the original -but I did get far enough into it to notice one crucial difference between the remake and the original.
In both movies, an old man in the woods is attacked by the Blob, which sticks to his arm, and is then taken to get help by teenagers that find him. In the orignal film, they bring him to the town doctor, who is about to leave town on business. The doctor immediately forgets his previous plans and brings the old man into his office for treatment. The doctor sifts through books, and calls friends to attempt to diagnose the problem with the man's arm. He is clearly dedicated to helping the old man and the idea of payment is never even mentioned.
In the remake, the teenagers bring the old man to the town hospital, but when they rush him to the front desk, they are greeted by an indifferent secretary who simply asks if the man has health insurance. The two teenagers become very upset and irritated at this point. The old man is eventually led into a room, and apparently forgotten. The doctor is uncaringly sitting at his desk doing paperwork.
If each movie can be considered a reflection of the time it was produced in, a case may be made against government interference in healthcare. In the 1958 version, the doctor is apparently providing healthcare because he feels that it is his duty to do so, not because he is looking to make lots of money. In the 1988 version, the hospital is clearly only giving healthcare to make money, and it does not deem human well-being important. If one remembers Ron Paul's discussion on healthcare in "The Revolution: A Manifesto," this difference makes perfect sense. Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it. He then goes on to say that this benevolence ended when the government increased regulation on the healthcare industry (in the sixties), making free healthcare too expensive to give.
So there you have it- the same story, with two different scenes (which doesn't really matter to the story, because the Blob does what it does best in both cases). Now, I don't really like it when people make art into things that it's not. But I really do think that each movie is accurately reflecting its own time period, and I think that government interference may be resonating even through the movies we watch. Really though, I just wrote this article for a little fun. Beware of the Blob! [And government :)]
...the US Health System just needs more people who stand to make a significant short-term profit from all citizens who are healthy and treated promptly.
1. Uniform billing codes and realtime price-lists so that we know we're not getting ripped off. California's chargemaster publication requirement is a step in the right direction, but it needs to be updated more quickly, and rural hospital exemptions are BS. If you can run a hospital, you can update your billing DB no matter where you are.
2. No anti-trust exemptions. This is so fundamental it's mindblowing.
3. Nationwide competition.
4. No more buyer's clubs. If the doctor and/or hospital is *licensed* then the insurance must pay out. You get to keep your doctor no matter what. Any company that wants to keep having a buyer's club can do that; but you can't be compelled to purchase into a club, only real insurance.
5. Real insurance means you can't lose your life savings due to a percentage payment or a cutoff. After all, you can't actually insure health. Only genes and behavior can do that. When we talk about health insurance, we're really talking about medical bankruptcy insurance, and the current system fails to do that. In order to be considered a real insurance plan, you have to prevent medical bankruptcy. That means, for example, you can lose no more than 10% of your net worth or income in any calendar year. That way, you could be severly ill for 5 years, on chemo, and emerge with roughly 60% of your life savings intact instead of nothing.
6. Stop torturing doctors. No, really. Many people won't even consider med school because it's torture. Maybe we need to put some doctors through boot camp. Maybe it's important for brain surgeons; but I can't imagine this system is really doing much to increase the number of competent family doctors.
7. Malpractice/tort reform. Duh! If a doctor is so incompetent that we're better off taking him out of the profession then let's do that. Requiring all the other doctors to pay out as if they're that bad is insane. Multimillion $ payouts won't bring back your relative. License revokation, however, will prevent it from happening to somebody else. Note, this is tricky since it's possible for competent people to make mistakes. You actually need to make sure that the number of mistakes is statisticly significant. Otherwise, nobody will want to risk becoming a doctor (see point 6). Statistics is a bizarre thing. There's actually an expected number of botched operations; but the odds of a single doctor botching 10 operations in a row are probably low enough so you can safely conclude that doc needs to lose his license.
8. Everybody self-pays and submits claims. That's right. You run healthcare like a normal business. I know it's hard to believe, but it really is just like buying a loaf of bread. Fire the beurocrats. No biggy. They'll get free health care while they look for a real job.
9. No paper work until the patient is well. No signing anything under diress.
10. You can put a pharmacy in the hospital. Quit making sick people drive to get meds.
Some quotes from the AMA themselves:
"Not a single allopathic medical school opened its doors during the 1980s and 1990s
I think we can agree that it's unreasonable to have 99.999% of the applicants on one side of the line or the other, but beyond that? What about taking only the best 10%, or only the best 90%, would one of those be OK with you?
How about 98% rejection rate? From the AMA article above: "Many private medical schools have 5,000 or more applicants for a class of 100 students."
Again, I hope it comes across, I know something about this issue. I said "ostensibly qualified" and "more than half" in my OP because I didn't want to get into a big debate about the exact percentage of people who apply and are grossly underqualified and rejected versus the legit applicants who are rejected, but basically the former is not happening, since you need to take the MCATs (not easy) and complete the equivalent of a degree in Molecular Biology simply to even apply to med-school (and currently to be competitive you need hundreds of hours of volunteer work, professional medical experience such as EMT work, and even then it is often a crapshoot, I know many qualified applicants who have been rejected more than one year in a row).
I am Jack's complete lack of surprise.
You're right that the money isn't there, but we can still promise the care. We don't have the stomach for death committees or official rationing. We will refuse to accept the problem.
Of course, the waiting lists will grow as required to ration out the supply. Everybody gets healthcare, except the people who die while waiting for treatment.
Maybe you can bribe your way to the front of the list, make friends with a senator, or claim to be part of some disadvantaged group that needs special treatment. The blackmarket possibilities are endless.
For most of human history our ability to care for the sick has been limited by knowledge. It was relatively easy to do everything we knew how to do. So we have this idea that we need to do everything possible to help people. The trouble is our medical knowledge has rapidly outpaced our ability to pay for it. We argue a lot about how to give everyone the best medical care, but that just isn't possible. What we need to do is decide how much of our wealth we want to spend on medical care and then worry about spending it well.
science has... enumerated and identified... more than 13,600 diagnoses — 13,600 different ways our bodies can fail. And for each one we've discovered beneficial remedies... But those remedies now include more than six thousand drugs and four thousand medical and surgical procedures.
It's too bad that Western medicine doesn't have a comprehensive guiding philosophy. Imagine if they taught principles like these in M.D. schools:
Western medicine plays whac-a-mole with the body's symptoms - a pill for high blood pressure, a pill for acid reflux, a pill for high cholesterol, ad infinitum - while health practitioners guided by superior philosophies (there are many) try to distill down to the fundamental reasons for a given body's dysfunction.
The brand of medicine represented by this commencement address is defective because medical education was hijacked by the Carnegie Foundation (who represented the drug trusts). My favorite articles on this bit of history are 100 Years of Medical Robbery and the followup, Real Medical Freedom. "How The Cost-Plus System Evolved" (pt 1, pt 2, pt 3) is also well-written.
US Healthcare needs guiding principles: nothing more, nothing less.
/.tivism? Slashtivism? This is the first time I've seen the editors directly come out on the side of a political issue in the form an article on the main page.
I once took an excursion to Reddit, and later HN. Unlimited up/down voting sucks when dealing with a hive-mind.
In US 50 years ago a family of 4 could have actual health insurance (covering of up to $50,000 of expenses, which was enough for everything) for a year for $25 dollars (payment for an entire year!) with a $500 deductible.
Multiple attacks on this happened since that time, especially during Nixon administration. Government got into the business of doling out money to medical workers and just like with government giving out loans for education this lead to rising costs for everybody, just like it leads for universities raising their costs.
Basic problem is the government giving out public funding for any sort of endeavor. This leads to very rapid price increases. Before Nixon, a day in a hospital could cost $100, today it could cost up to 100 times that much. Obviously this has nothing to do with inflation. Costs to treat cancer could go as high as up to 20,000 dollars before then, now it could easily reach between 500,000 to a cool million.
Any time a government is involved in giving out money, the costs for any services/products go up because .... because they can go up, because there is a government guarantee that no matter what the costs are to the public coffers they will be covered.
In the infamous words of Nixon himself: "it will cost no American more than he can afford to pay". Then he yapped something about how no new taxes would be used, only existing public money (so as always, this includes your social security money).
AFAIC all government behavior that touches economy leads to pyramid scheme being created.
As long as government gives out money through laws for certain items/services and collects this money through taxes+borrows it+prints it, there is nothing that can stop the prices for the items/services to skyrocket way above what markets can bear.
Government is an anti-competitive, monopoly creating machine that destroys economy by causing massive inflation and kills productivity by regulations and tax laws that kill small business. All of this is obviously done under the guise of doing some form of good.
Get government out of economy, take government's ability to screw with market prices out of the equation, take away government's ability to kill off small business through regulations and various taxes, take away government's ability to create/maintain monopolies through giving out money/special privileges and take away government's ability to cause inflation through printing money/borrowing, take away government's affinity to corrupting everything around it through income taxes, switch to a sales tax + allow people who are poor to file for tax refunds, take government power out of economy and you will see the return of SANE prices on things, sane prices on sane insurance plans.
Of-course there is a matter of shortage of doctors - this is about the collusion that prevents the necessary number of medical professionals to enter the business, this also needs to be addressed, this creates monopolies just as well as free money.
You can't handle the truth.
is for people to realize that "Health Care" is (read: 'should be') concerned with people's health and not be thrown around as "injury care". If someone goes out on vacation to go bungee jumping or runs a recreational boat into a bridge pier, there's no reason that my taxes should pay for injuries that were induced by a conscious (idiotic) decision on their own part.
Now, providing "health care" to people who have health problems? Yes, that's what Health Care is.
Cuba has a dog and pony show.
I already warned you in my original post not to trot this shit out, because I'm not some idiot who happens to have seen a Michael Moore film and now thinks Cuba is a utopia. Instead I'll choose to believe the guy who runs Harvard Medical School's Social Medicine program (see: end of my original post), Jim Kim MD (former Prof of Medicine and Chair of Global Health for Harvard Medical School, now president of Dartmouth), and the World Health Organization, amongst many other credible sources.
Because I am busy and you make no effort to substantiate your claims, I'm just going to paste a chunk from Tracy Kidder's (Pulitzer Prize winner) biography of Dr Farmer, where Farmer talks to Kidder about dispelling myths about Cuba (and then after that some of Farmer's own writings)...
"For me to admire Cuban medicine is a given," Farmer said. It was a poor country, and made that way at least in part by the United States' long embargo, yet when the Soviet Union had dissolved and Cuba had lost both its patron and most of its foreign trade, the regime had listened to the warnings of its epidemiologists and had actually increased expenditures on public health. By American standards Cuban doctors lacked equipment, and even by Cuban standards they were poorly paid, but they were generally well-trained, and Cuba had more of them per capita than any other country in the world-more than twice as many as the United States. Everyone, it appeared, had access to their services, and to procedures like open heart surgery. Indeed, according to a study by WHO, Cuba had the world's most equitably distributed medicine. Moreover, Cuba seemed to have mostly abandoned its campaign to change the world by exporting troops. Now they were sending doctors instead, to dozens of poor countries. About five hundred Cuban doctors worked gratis in Haiti now-not very effectively, because they lacked equipment, but even as a gesture it meant a lot to Farmer.
One time he got in an argument about Cuba with some friends of his, fellow Harvard professors, who said that the Scandinavian countries offered the best examples of how to provide both excellent public health and political freedom. Farmer said they were talking about managing wealth. He was talking about managing poverty. Haiti was a bad example of how to do that. Cuba was a good one.
He had studied the world's ideologies. The Marxist analysis, which liberation theology borrowed, seemed to him undeniably accurate. How could anyone say that no war among socioeconomic classes existed, or that suffering wasn't a "social creation," especially now, when humanity had developed a grand array of tools to alleviate suffering. And he was more interested in denouncing the faults of the capitalist world than in cataloging the failures of socialism. "We should all be criticizing the excesses of the powerful, if we can demonstrate so readily that these excesses hurt the poor and vulnerable." But years ago he'd concluded that Marxism wouldn't answer the questions posed by the suffering he encountered in Haiti. And he had quarrels with the Marxists he'd read: "What I don't like about Marxist literature is what I don't like about academic pursuits-and isn't that what Marxism is, now? In general, the arrogance, the petty infighting, the dishonesty, the desire for self-promotion, the orthodoxy. I can't stand the orthodoxy, and I'll bet that's one reason that science did not flourish in the former Soviet Union."
He distrusted all ideologies, including his own, at least a little. "It's an ology, after all," he had written to me about liberation theology. "And all ologies fail us at some point. At a point, I suspect, not very far from where the Haitian poor live out their dangerous lives." 'Where might it fail? He told me, "If one pushes this ology to its logical conclusion, then God is to be found in the struggle against injustice. But if the odds are so p
I am Jack's complete lack of surprise.
It's called Medicare. It's a large percentage of federal spending right now, and it's projected to exceed 100% of all federal spending by about 2020, baring any changes.
Would that be the same Medicare were congress has been looting the fund and leaving IOUs? Or is that Social Security? It's hard to keep boondoggles straight these days.
Insurance companies, hospitals, and even individual doctors are profit driven.
While it is certainly no crime to make a dollar, that dollar shouldn't be THE_MOTIVATING_FACTOR in health care.
If/when every doctor, every hospital, and every insurance agent actively seeks to provide the best REASONABLE care possible, at the lowest REASONABLE cost possible, then we will have gone a long way toward solving our health care problems. Ambulance chasing lawyers need to be reigned in as well. An accident in which a person's neck is broken should involve some pretty big money - but the sum of money involved shouldn't guarantee that the victim can live on Easy Street with all his freinds and relatives for the rest of their lives, either. Worst of all - those ambulance chasers pocket half the settlement anyway, so the victim is screwed in the end, no matter what!
And, insurance fraud needs to be punished much more seriously than it is today. Any moron who defrauds an insurance company should get automatic prison time, the sentence to be determined by the amount of the fraud. 1 year for each ten thousand dollars sounds about right to me, sentences to include any and all executives of any companies involved.
In short, let's clean up our act, and stop looking at health care as a cash cow. Start looking at health care as an obligation to take care of each other. And, ourselves, of course.
"Windows is like the faint smell of piss in a subway: it's there, and there's nothing you can do about it." - Charlie Br
Buffet style insurance is a huge part of the problem. People don't see the costs of their health care, and they're accustomed to getting as much as they want (not need) for a set amount of money, much of which is paid "magically", "somehow" by their employer.
So what is the cost of a human life?
Shai Schticks:"You don't make peace with friends, you make peace with enemies"
For just about everything else in life, insurance is just that: Ensuring that in the event something happens, you are covered. It is a risk transfer for certain situations. For example I carry insurance on my house. In the event it burned down, or everything was stolen or the like, I could not afford to replace it all. My cash reserves are insufficient and, indeed, I have to have a mortgage to own the place. So, in an emergency, the insurance company will cover my loss. However, it is only in an emergency. They do not cover regular maintenance and upkeep of the house. Even in terms of qualifying emergencies, like theft, there's a $500 deductible. So if someone breaks in and steals a couple speakers, I'm paying for that myself, but if they steal everything the insurance company will pay.
It is all about transferring risk. I take care of the high risk, low cost stuff, they assume the low risk, high cost stuff. It is a certainty I'll have to repair things, the risk of something breaking down is as high as it can be, more or less. But the cost is low, I can afford it. The risk of my place burning down is quite low, but the cost is high, too high, so I transfer that risk. Doesn't cost a lot, since it is low risk. Likewise, my insurance company does the same thing. They cover individual incidents. However for large things, like disasters, they have their own reinsurer. That company only deals with extremely rare stuff, the risk of it happening is minimal, but the costs are astronomical.
But for health insurance, that's all turned around. It covers EVERYTHING. I pay, at most, $10 for anything. Insurance pays the rest. Doctors visits, tests, hospital, etc. I only bear the cost if it is extremely cheap, like a generic drug. Otherwise they pick it up. However they also pick up high cost stuff. If I have a major accident and require intensive care, they pick all that up. They are liable for ALL risks to my health.
Is it then any wonder that it costs more per month than my home insurance does per year?
I really thing a medical savings account kind of plan is the right idea. You save money to pay for normal things. In the event of something catastrophic, no problem, your insurance is there to pay any and all costs.
However finding that is hard. They started offering one at work... And it wasn't worth it. My premiums stayed the same, my employer had to put in just as much money, and my personal financial risk increases. How he hell is that useful? It should cost my employer much less, but it doesn't.
Your suggestions tells poor people who happen to have a handicap or chronic condition to get stuffed.
You sir fail at humanity. Congrats, you can now enroll in US politics.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
OP here. Infant mortality rates? Yeah, there are two ways to measure them. Yeah, Cuba uses a marginally different one that makes their stat slightly better. And they "cheat" by having widely available abortions. When it comes to their life expectancy do they "cheat" by reanimating their dead? Because we also have life expectancy on parity with them, despite the fact that they have a per capita income of something like 1/5 of ours (off the top of my head) and according to you "dog and pony show" medical care that amounts to utter neglect. So why do they live as long as us?
Regarding your source:
1: good job linking a right wing thinktank. Funded by philip morris and headed by a former coordinator of Bush campaign? I'm SHOCKED that they don't like Michael Moore's film, haha.
2: i win a prize for calling it... you're a disgruntled Moore hater. Well, so what. Get over it, and start contesting some of the legitimate non-fiction academic literature on Cuba instead of stuff that plays alongside action movies in theaters across the US.
Even poor people in the US have access to multimillion dollar equipment and highly trained doctors, expensive medications, etc... Do you really think a little shithole poor country like Cuba has better healthcare?
Tiger Woods is a billionaire. So I'm sure he wear condoms all the time he's banging cocktail waitresses, right? That's about the same sort of stretch in logic you use above.
SOME poor people have access to multimillion dollar equipment in the US. And for every one of them, there are 20 persons who have health insurance, get cancer, and are dropped by their insurance company or denied coverage (because a commission is paid to reps every time they find a way to deny coverage, and those who don't are fired). The vast majority of American poor are victims of structural violence, are highly marginalized, and have essentially no access to first world medical care.
Yeah, and the movie Birth of a Nation supports the case for the KKK, while the movie Terminator 2 supports the case against improving computer technology. Lets all base our political decisions on this.
"I don't care about the Constitution!" --Bill O'Reilly, November 17, 2009
Dr. Gawande suggests the "13,600 different service lines [doctors] deliver" is an issue in health care costs. I put forth these comments:
* How many services are listed in the manual which guides the number of hours an auto mechanic is allowed to charge for a repair, e.g., replace spark plugs: 0.75 hours. How many items are in this book?
* How many different services does a software engineer deliver over a year's time?
I suggest the problem is related to control over charges. Car mechanics have a job with similar complexity to what doctors face. Software engineers often face a problem much more complex. (How many "surgeries" require several weeks to solve a single-line bug?)
The control of health care "service" in the US is in the hands of the AMA and the bureaucracies created around hospitals and other facilities. If they were willing to reduce their profit margins (assuming we can eliminate the defaults they see because of uninsured/under-insured patients), we could see significant reductions in general health-care costs.
This is just a thought...
-Todd
Omne ignotum pro magnifico.
Ron Paul writes that when he became a doctor (in the fifties), it was standard for doctors to give free healthcare to those who needed it, but couldn't afford it.
Was this before or after they stopped exchanging chickens?
"I don't care about the Constitution!" --Bill O'Reilly, November 17, 2009
2) Effective heath care
3) Obscene corporate profits from health care
As long as corporations control our government, number 3 is not optional.
We don't see the world as it is, we see it as we are.
-- Anais Nin
ACing this since you posted as AC above (where I replied as AC and refuted your infant mortality claim).
First, if you have any background in health you know the different between determinants and indicators. You can cherry pick whatever indicators you think will militate best in your favor. And when they don't militate the way you'd like (say: infant mortality) you will claim they are "cheating" by offering abortions or by using a marginally different method.
Allow us to get into the technicals of the method they use. Using your OWN LINK's info, the US method includes less than 1.3% extra babies, of whom 50% may die (less than this but we'll round up. So instead of 6.0 per 1000 for Cuba and 7.2 for the US The US actually has (.5*1.3%) better stats. So 7.1532 instead of 7.2. Wow, who cares. Furthermore, even if we ignore all of this and say that US IS BEST EVER for infant mortality, Cuba still trumps several other "first world" countries that have way more GDP/PPP and use the SAME method of measurement as Cuba. So their indicator holds.
Furthermore, this is ONE indicator. Life expectancy is another important indicator, and one you can't explain your way out of so easily, especially if Cuba has such a horrible medical system the fact that they live approximately (but not quite) as long as Estadounidenses again speaks to their health outcomes. Or their abilities at reanimating their dead.
You cherry pick breast cancer survival, which is a pretty random and focused statistic. I don't think you want to get into the "focused indicator game" with me to prove which country has better health outcomes. How many people does breast cancer kill in the US? Instead of arguing if Cuba wins or loses here, I'll just let you have it. Now how may people do GUNSHOTS kill here? How many in Cuba? Drug overdoses? Car crashes? You will lose the focused indicator game. Most resident doctors in Havana's hospitals have never seen a gunshot wound. Or a drug overdose.
And when we dig deeper into indicators, and I mean overall indicators, not narrower ones that are likely to show more bias, things get interesting. US life expectancy is one thing, but the distribution of life expectancy tells us a whole lot more. Which is to say that black men who live in Harlem have a shorter life span than the average Bangladeshi. So yea, if your last name is Buffet or Rockafeller you're gonna live maybe even 10 years longer than the average Cuban (if you're really lucky), but for the million of marginalized minorities in the United States, you'll probably live 10 years less. See: Hans Rosling's work.
Lastly you are either an idiot (i don't think so) or disingenuous to characterize experts who literally write WORLD HEALTH policy as "enchanted foreigners." If you or I went to Cuba and came back with a glowing review, we might fairly be viewed as "enchanted." When the world's foremost health equity experts have glowing reviews it is ignorant and dismissive to call them "enchanted." I cited people who run the top medical schools in the world. You cited a Philip Morris funded web site. Game, set, match.
You take that money and put it in that lock box Al Gore was going on about in 2000, so that Republican raiders can't get their grubbies on it.
I doubt that will help much since you have given Democrats the key to that very box. And they are very, very hungry to make use of the contents as they have shown over the last year - even moreso than the last batch of Republicans.
Your "public option" fan fic was amusing, though once you see in real life what happens when you let people take as much as they can for free it of course goes all to hell.
"There is more worth loving than we have strength to love." - Brian Jay Stanley
...an acolyte of St. Free Economy, I see.
Gone anaon due to work-related opinions...
This guy wrote a book. He was on NPR recently toting it around.
The Checklist Manifesto: How to Get Things Right
http://www.amazon.com/Checklist-Manifesto-How-Things-Right/dp/0805091742/ref=sr_1_1?ie=UTF8&s=books&qid=1277108854&sr=8-1
It's a good book. I bought it because some of the IT goons in my department had a hard time doing things correctly, consistently. Or, more honestly, they are a bunch of f--k-ups who need to be fired, but the boss won't. Make a flippin checklist. Google uses checklist. Smart people use checklists. Nobody with a brain expects themselves to do things 100% right 100% of the time, but when it counts for things like airplanes and surgery (how about oil rigs?), make a flippin checklist and have your work cross-verified by someone else.
This goes for server work and code too.
The US medical culture is often about "doing everything possible" (more often when you are both white and non-poor), and our infant mortality stat is measured differently, but this difference is marginal at best.
The difference is basically as he said, we try to save babies that are below 1KG in weight, and half of those die, and we count that. Other countries don't. BUT! The total number of births below 1.5KG is only 1.3% so this does not significantly affect the stat. The number I am citing is from his OWN LINK where he is arguing this point elsewhere in the thread.
I don't think the post above needs to be modded troll, but it's important for people to understand the difference in infant mortality measurement is marginal, and the US is the outlier in how we record these deaths.
What this country needs is a good $5 plasma weapon.
13,600 distinct services seems like nothing to me. Seriously.
In a given month, I personally perform roughly 300 distinct "lines of service"/service items. This is in IT, as an administrator. Yes, I personally perform that many distinctly different tasks for users on a given month (whether they realize it or not).
So why is this such a difficult thing for doctors? I don't get paid a fraction what doctors do, and it's not like they aren't prone to errors in diagnosis - so that's certainly not a valid excuse for the rate difference.
There isn't anything special about a doctor's diagnosis, honestly, unless they're a specialist. More often than not, 20 minutes on the internet will lead you to the solution you need for most common ailments. Usually, it's something routine: you've got a mole that needs removal; you need antibiotics; you have an annual checkup (which is a list that every doctor goes through and is quite standard).
So why is it so damn expensive? Institutionalized education, on top of institutionalized budget abuse at every level of healthcare because "we need it"?
Fifty years ago may have had "poor diagnosis" and what have you, but "take a stiff drink and call me in the morning" did just fine for most of the instances where people would get a 10-day run of antibiotics today. Yes, that's exaggerated, but so is the effectual significance of "modern healthcare" on actually improving the lives of the common man. The "health" improvements we've seen in the last decade+ can largely be chalked up to people returning to healthier natural diets, not the wonders of modern medicine.
~/ssh slashdot.org ssh: connect to host slashdot.org port 22: too many beers
Seriously we do. Or at least a huge part of it. I am a long time slashdot poster but I am embarrased to post this under my own handle.
The company has some really phenomenal ideas, with goals that are extremely clear and achievable.
Our problem? It's nearly impossible to find software engineers who are passionate enough to work on this problem domain.
We have went through a lot of crap developers. One of the problems is that developers see the problem as overwhelming,
spend endless time debating ideas that don't concern their work, and when they do produce software it is overengineered.
This seems to happen even when their assigned task is small and achievable. Their productivity is consequentially terrible.
The simple ideas our company is founded upon invetiably become mired in complexity and inertia, no matter how much I try to stop it.
I have regretted hiring 4/5 of our development team for different reasons. I have recently let go most of them, because I am certain that over
the last 6 months or so much more would have been accomplished had I (as the founder of the company) worked on this by myself. The
tension this situation has created has alienated the one good developer I had working for me, and it's quite likely he will be leaving the company.
It has gotten to the stage where I have considered lying to new hires about the entire mission and goals of the company, because
some of the software we are writing is really notthing special. The specification of the software could be described for something trivial
and inconsequential. Pretty sad stuff, but that is the power of preconceived notions.
I mean come on, more than $400K a year AVERAGE salary for non-operative (I assume they mean consultations only) cardiologists? This comes from this Sunday's NYTimes magazine article "What Broke My Father's Heart).
ACing because I don't need ego-stroke or karma for reposting, but since you want the cite:
Erwin Ackerknecht's A short history of medicine, page 224. This is on Google Books if you doubt me. Quote:
"There were no less than four-hundred medical schools in the US in the nineteenth century. [skipping less than a sentence] ... and it was not until 1930 that the number had been reduced to seventy-six well-qualified institutions."
Incidentally I agree with the rest of your post, and many of the 400 were certainly diploma mills or quackeries. My point is that we have expanded as a nation, aged as a population, and reduced the number and proportion of doctors we create. Bad idea if your foremost goal is public health.
Yeah, government clinics for the poor, and they just happen to have the worsed equipment and the place where the big pharmacuticals do their testing.
You know, most of the developed world has sorted this out a long time ago. It is called socialism. Embrace it or die.
MMO Quests are like orgasms:
You may solo them, I prefer them in a group.
Johnson was the first President to raid Social Security for money for the general treasury.
Guess where this oh so enlightened liberal spent it?
Vietnam...
This article doesn't explain why health care in the US is five times more expensive than in most countries in Europe. I live in Amsterdam, I am single, I pay $120 a month, full coverage, no co-payment, no dentist.
no, I don't have a sig
Less endemic morbid obesity.
Finally had enough. Come see us over at https://soylentnews.org/
it is simply because they are paying a large amount on a smaller number of people. The ratio of administrative (records, tracking and such) makes up a larger percentage of the cost of managing a healthy patient than an unhealthy one. Think of it this way, if I go to the doctor four times a year for a check up and at most one real event the costs to track me will take a higher percentage of my overall health care dollars compared to Joe, the 70 year old who ends up in the hospital for a twelve thousand dollar visit.
So if my health care costs for four visits were $600 I am quite sure the admin of tracking that is amazing higher in percentage than tracking Joe who racks up twelve thousand in one shot.
Sure Medicare will work, if you force young healthy people who don't need such coverage to pay for it. I am sure they are going to love it. They will get what they deserve in the end, electing people to give them stuff sounds good because they themselves never expect to pay for it. Any workable Medicare system will require ALL people pay where opt out penalties are higher than staying in.
The "Health Care bill" was designed to drive privates out by forcing them to insure those who wanted it and letting people who didn't want to chip in to pay a penalty to the government. As in, put all the onus on one side. Funny how the solutions when offered by the government as sole provider don't follow the same rules.
* Winners compare their achievements to their goals, losers compare theirs to that of others.
Healthcare in the US isn't close to 5 times as expensive if you are going to base that on your personal healthcare.
I pay $150 a month, full coverage, $20 copay for most issues, $50 copay for a specialist (x-rays, lab work, etc), full dental coverage (oddly enough x-rays included), $10 prescriptions delivered to my house (no waiting at a drugstore), $300 hospital stay (up to 30 days). This is on COBRA. When I was employed, it was around $55 a month.
Private insurance for someone my age and etc is less than $200 a month (your service level may vary, thats why you shop around and have competition for private insurance).
Of course, the article doesn't address your blatent lie because it isn't about the differences between US and European healthcare, but rather about why quality care is not uniform (the article is inaccurate, the problem is that many doctors are not good doctors and like any profession, the better doctors tend to charge more while actually helping their patients more effectively).
Bingo. Got it in one.
I work in the public health system in Australia, and it is going down the tubes. So much public money is being spent keeping people alive for decades because of self-inflicted illnesses. Type 2 diabetes is the next "epidemic" we're told to expect but it is almost always a direct consequence of known lifestyle choices.
"Bariatrics" is now a specialty. We spend thousands on super-size wheelchairs for fat bastards but aren't allowed to say they are fat bastards. We will modify their houses for them free of charge, as if morbid obesity was a sudden injury like a spinal injury.
We hand out, install, service and support dialysis machines for renal patients who are the "victims" of their own stupid choices. Some genuine cases of kidney disease, yes, but a lot of lifestyle stuff.
I love working in public health. Being able to make sick people well again is great, but we are being dragged down the toilet by people who don't give a rat's arse about their own health and just seem to revel in making the rest of us wallow in their shit.
PS love the name. Cool album.
When they came for the communists, I said "He's next door. Take him away. Goddam commies."
How about corporate officials making no more than 40 times the pay of the lowest-paid health worker?
then we would be further along at not being sick all the time, freeing up resources for those who never have any choices.
the corepirate nazi illuminati is always hunting that patch of red on almost everyones' neck. if they cannot find yours (greed, fear ego etc...) then you can go starve. that's their 'platform' now.
never a better time to consult with/trust in our creators. the lights are coming up rapidly all over now. see you there?
meanwhile (& it may be a while); greed, fear & ego (in any order) are unprecedented evile's primary weapons. those, along with deception & coercion, helps most of us remain (unwittingly?) dependent on its' life0cidal hired goons' agenda. most of our dwindling resources are being squandered on the 'wars', & continuation of the billionerrors stock markup FraUD/pyramid schemes. nobody ever mentions the real long term costs of those debacles in both life & any notion of prosperity for us, or our children. not to mention the abuse of the consciences of those of us who still have one, & the terminal damage to our atmosphere (see also: manufactured 'weather', hot etc...). see you on the other side of it? the lights are coming up all over now. the fairytail is winding down now. let your conscience be your guide. you can be more helpful than you might have imagined. we now have some choices. meanwhile; don't forget to get a little more oxygen on your brain, & look up in the sky from time to time, starting early in the day. there's lots going on up there.
"The current rate of extinction is around 10 to 100 times the usual background level, and has been elevated above the background level since the Pleistocene. The current extinction rate is more rapid than in any other extinction event in earth history, and 50% of species could be extinct by the end of this century. While the role of humans is unclear in the longer-term extinction pattern, it is clear that factors such as deforestation, habitat destruction, hunting, the introduction of non-native species, pollution and climate change have reduced biodiversity profoundly.' (wiki)
"I think the bottom line is, what kind of a world do you want to leave for your children," Andrew Smith, a professor in the Arizona State University School of Life Sciences, said in a telephone interview. "How impoverished we would be if we lost 25 percent of the world's mammals," said Smith, one of more than 100 co-authors of the report. "Within our lifetime hundreds of species could be lost as a result of our own actions, a frightening sign of what is happening to the ecosystems where they live," added Julia Marton-Lefevre, IUCN director general. "We must now set clear targets for the future to reverse this trend to ensure that our enduring legacy is not to wipe out many of our closest relatives."--
"The wealth of the universe is for me. Every thing is explicable and practical for me .... I am defeated all the time; yet to victory I am born." --emerson
no need to confuse 'religion' with being a spiritual being. our soul purpose here is to care for one another. failing that, we're simply passing through (excess baggage) being distracted/consumed by the guaranteed to fail illusionary trappings of man'kind'. & recently (about 10,000 years ago) it was determined that hoarding & excess by a few, resulted in negative consequences for all.
consult with/trust in your creators. providing more than enough of everything for everyone (without any distracting/spiritdead personal gain motives), whilst badtolling unprecedented evile, using an unlimited supply of newclear power, since/until forever. see you there?
"If my people, which are called by my name, shall humble themselves, and pray, and seek my face, and turn from their wicked ways; then will I hear from heaven, and will forgive their sin, and will heal their land." )one does not need to agree whois in charge to grasp the notion that there may be some assistance available to us(
boeing, boeing, gone.
If it wasn't costly, why was there such public support for the introduction of the NHS in post WW2 Britain?
If it wasn't effective, why did they want it?
Confucius say, "Find worm in apple - bad. Find half a worm - worse."
in the "socialist" world, health care is not a problem.
Government driven non-profit means there is no billionaire in the chain demanding his pound of flesh.
We need to take the direct money out of front line medicine, or at least pay it much more cleverly. For example, if you pay doctors by results (percent patients cured) they will only work on easy cases. Almost any such system I can think of can be gamed.
Which is yet another reason to dump the entire concept of prepaid medicine to begin with. Sure, keep true insurance around for catastrophic events, but otherwise let each person decide how to spend their own money on their own regular health care. .
I believe there's a tradition in China where you pay your doctor every month that you are healthy. However, once you become ill you stop paying him and he now has an incentive to get you better.
Of course this could set up its own set of reward-based behaviours, but it'd be interesting to examine.
You called me an idiot, while you are staring right into the problems face and being totally blind about it.
You think he's wrong despite what he says. I suspect strongly that you haven't even read it deeply.
Once the government guarantees that it will pay, the incentives to keep prices at what the market can bear disappear.
If that is true, then why is health care so much cheaper everywhere else in the world - where the government really does guarantee to pay?
Government provides a gigantic moral hazard, you are looking at it and completely not seeing it.
What an awesome argument! Way to go brains! Did it ever occur to you that what you think you can "see" is just the play of neurones? It's not actually real.
If the government is such a huge moral hazard, then perhaps you should go live some place without a government - say like Somalia. No government there. Just pure economics. Paradise!
You buy civilisation with taxes,and that must be administered by government. Far from being a moral hazard, the collective spending and government administration is the basis of a functioning economy. It really is a question of what qualifies as efficient and worthwhile.
If private industry cannot do better than a government institution, then why prop up an inefficient private solution? That is precisely why we have public fire fighters.
Or is that a big moral hazard as well??
No wonder you immediately start with an ad-hominem, you have no intelligence to do otherwise.
Psychologists call that projection
Like all pain, suffering is a signal that something isn't right
The problem is that medicine is seen worldwide as a business, as in other businesses where the only objective is to maximize its profit. And that's not counting the medical courses are usually so expensive that only rich kids can have them, attracting people who are only interested in money rather than save lives. Medicine can not be seen as a mere ... business.
Religion: The greatest weapon of mass destruction of all time
I suppose to the many in the slashdot community it may seem that way. It sure seems to me that the whole premise here presupposes that complete and total health care is a right.
Last time I read the constitution, it wasn't.
To put this "Health Care" crisis in perspective, Americans spend about three times as much on transportation as they do heath care.
Of course we would wouldn't want facts to get in the way of our political agenda.
Let the flaming commence.
Your plan sounds excellent - where do you live, who's your provider? Oh, and what % does your employer kick in?
These are real questions, since I employ people in NYC, and have just been going over health plans to figure out how to reduce the cost.
The article is interesting in stressing the need for a more systematic approach to medicine in the hope of providing both better care and lower costs. That will improve things but it does not solve the fundamental problem.
The fundamental problem is the inherent improper design of biological systems which results in aging. As organisms age components fail and need treatment, repair or replacement. As the fraction of the population which requires these therapies increases costs will increase. Period. There are only two ways to solve this. Agree that because the biological systems are failing and will eventually lead to death we should reduce the level of care provided to these failing systems. Or redesign the systems so that they are more resistant to aging -- i.e. eliminate aging. If one eliminates aging one eliminates a significant fraction of the anticipated increases in the costs of health care.
Now as is usually the case the devil is in the details. What causes aging? Largely the inherently poor design of the system, e.g. energy production methods (the electron transport chain in the mitochondria) which produces free radicals which in turn damage the DNA producing point mutations and/or DNA double strand breaks the repair of which cumulatively corrupts the genetic program of each and every cell in the body until one ends up with either cancer or "aging" [1]. From a programmer's perspective each and every program in the trillions of cells in an adult human's body is becoming corrupted and will eventually fail. We have replacement capacity for some of those programs through our stem cells but those programs become corrupted as well. Until we have the ability to replace or repair the declining genetic programs we will not solve the increasing costs of health care.
Note that one can replace the programs in bulk (organ transplants) and there is an X prize pending for growing replacement organs from ones own stem cells. There are also a number of companies, e.g. Regenexx, BioHeart, etc. working on legitimate autologous stem cell therapies. There are also companies like 23andMe, Navigenics, etc. making personalized medicine available to the masses (so one can known what ones own genetic weaknesses are). And eventually if molecular nanotechnology develops quickly enough and we get real nanorobots like "chromallocytes" the repair of the cumulative DNA damage in each and every cell may become feasible (at low cost without the need for an operating room and a team of surgeons to perform a large organ replacement proceedure).
But until one starts seeing more people point out that the lack of clothes on the emperor (that the real problem is gradual genome corruption and "aging") and the need for a real "industry" to deal with it *and* the political problem that if you solve aging (so people live indefinitely [2]) then one is also going to have to touch the "third rail" of politics (social security entitlements) if one is going to avoid bankrupting nations [3] then speeches such as the one cited will miss the critical issues.
1. This isn't the only way the system is mis-designed. One could argue that the use of free radicals and inflammation by the immune system is questionable. On the one hand it may help to fight bacteria or viruses when one is wounded or otherwise exposed to them but at the same time the same processes probably contribute to heart disease. But heart disease can largely be dealt with through proper diet and exercise, and if necessary relatively inexpensive drugs, the same cannot be said for cancer and aging.
2. Indefinite lifespans are not "immortal" lifespans. Fatal accidents still have a non-zero probability.
3. All of the news debates about medical care costs, national debt, etc. (largely promoted by right wing politicians, new "Tea parties", etc. IMO) *all* ignore the probability that these perspectives largely disappear in light of molecular nanotechnology. People largely don't need Medicare if their genomes were better engineered to last indefinit
that those who oppose the idiocy of libertarianism are not "lovers of big government" as you say? why, why would we love big government? who would anyone? what is the motivation?
"oh, i am a sworn protector of bloated government bureaucracy, it is my burning passion" pffft
NO ONE loves big government. but we oppose libertarianism BECAUSE BE UNDERSTAND IT BETTER THAN LIBERTARIANS: it is clearly a road to hell
if you say "how could you understand libertarianism better than libertarians", well: do you understnad communism? do you have to be a communist to understand or oppose communism?
no: clearly communism is stupid, as it destroys society by removing any impulse to actually try and work. LIKEWISE, libertarianism removes the impulse to have any public good. libertarianism is simply social darwinism: humanity as craven selfish competing indivuduals with no rules, nothing to punish them for bad behavior, without the slightest concern for anyone else. a society of sociopaths
libertarianism is the mirror image of communism: the fanatical triumph of selfishness over altruism. much like communism is the fanatical triumph of altruism over selfishness. the truth is BOTH communism and libertarianism are dangerous destructive follies at either end of a spectrum. the ONLY true way to run a society is a MIX: socialism with capitalist engines, or capitalism with socialist safety nets
the MODERATE path is the only path that makes sense, because humans are a paradoxical mix of the selfish and the altruistic, and any ideology that addresses only one side of human nature fails to rule human beings, by not adequately reflecting who and what they are
we need GOVERNMENT, period. not BIG government. we're not idiots, we don't defend government blindly: government has problems, we need to FIX it. its an ongoing maintenance function that never ends
but libertarians want to THROW GOVERNMENT AWAY, to destroy it down to a cauterized ineffective nub. which is incredibly stupid. libertarians want this country to be like haiti or somalia, where there are a few ultrarich, legions of poor, abuses on every street corner, and the power vacuum of no government filled by mafias and corporations. libertarians may not actually say this is what they want, but this is the end result of their philosophy, whether they realize it or not
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
SCENE: dead of night, full moon, desolate plain near kandahar
a group of mujahideen slowly creep through the brush towards an american outpost, one takes aim at a sentry
just then, the ground starts to shake, the mujahideen lower their arms and look at each other helplessly. suddenly, a periscope pokes out of the dirt behind the mujahideen, and then the top of an entire submarine
"mustapha, the infidels are using sand submarines!"
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The big point entirely missed is that some aspects of US medical care are so broken that even Cuba can do things better than the US on average.
There are of course dozens of countries that do it better than Cuba, and some systems in the USA (Veteran's Hospitals etc) that are also better than Cuba.
To give an example of how insane the AMA/AAMC is I give myself as an example. I didn't do well in college(We're talking B-/C+ GPA) when I was younger but I got bit by the medicine bug in my early to mid 30's and went back to do a premed program as a post bacc. It was surprising how much I had grown up and changed and I did extremely well. Taking the standard premed coursework I had a GPA on that in excess of 3.9 and even got a balanced 33 on my MCAT. Anybody want to guess what I was judged on? Yup, that classwork that was on the order of 15 years old and not the stuff I had just taken. (You'd think someone like me would be a great to have in medical school since I was doing this on my own and not to please a parent and shown how much I wanted to do this. Instead I was judged on things that didn't reflect me at the time of application and was insulted behind my back which is really a dick move.)
Did you know 80 to 90% of the moderators on slashdot wouldn't recognize a troll even if one dragged them under a bridge.
that the us healthcare system is extremely broken and needs an overhaul is plainly and painfully obvious to anyone with half a brain
there does however seem to be a large inflamed population of completely propagandized idiots that oppose the overhaul, but so what? there's also a bunch of morons who support creationism who think evolution is controversial too, and that simply teaching evolution is "activism"
i guess simple common sense is "activism" to a moron
but really, when it comes to the healthcare system in the usa, there's no controversy: its horribly broken, and it needs to resemble the way it is in other, saner countries in the world
and that is a simple obvious fact unless you are a hysterical propagandized twit
heck, there are desperately poor countries with saner healthcare policies than the usa:
http://www.nytimes.com/2010/06/15/health/policy/15rwanda.html
you really wonder exactly what the hell motivates people to oppose universal healthcare. you look at the idea of it, your mind examines all of the pros and cons of universal healthcare, compare it to the current system the usa has, or some libertarian social darwinistic fantasy of people unable to treat broken arms because they don't have $100,000 in their bank account, and it is such a NO BRAINER OBVIOUSLY SUPERIOR APPROACH TO THE PROBLEM OF HEALTHCARE
you really have to wonder exactly what motivates those to oppose a system of care which is in their own selfish interest to accept! do these people believe they are immortal? that they are immune to a sudden accident they can't afford? or that if you can't afford insurance, or are too stupid to realize you need to buy it, that the rest of us can just go "well sucks to be you" and watch you die on the street? is that it?: do you have to be a sociopath not to accept universal healthcare?
what exactly are these morons who oppose universal healthcare thinking?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
After thinking about things for a bit, here's a simple statement of the health care "problem" - from a bias of being familiar only with the US system. I've also got a proposal that could address many of the issues while meeting most of the goals of a health care system.
As introduction, the marks of a "good" system might be: treatment at any given level is available to all independent of individual wealth (equality of care), there is enough care at a given quality to support the needs at that level (availability of service), there is an emphasis on preventive care, and cost to individuals is proportional to amount of service utilized (fairness of cost). These are pretty much the main arguments of the day - people want to get (good) care for everyone but it is not economically or socially responsible to have everyone pay the same amount personally to get massively different benefit.
My solution would be along the lines of requiring everyone to pay some baseline amount for insurance. This would be a small amount so everyone could afford it. Note that I would not exempt anyone from this small payment. But: If individuals go in for at least the basic regular checkups and basic preventive care, they would receive rebates that would offset this minimal fee. However, if you need more service than that, you must pay increasing amounts depending on the level of service needed.
So this is something like the Taguchi loss function - if society as a whole has zero health care that's a big loss so should have a cost (the "minimum fee"). But if people have basic care to prevent communicable disease, basic checkups, etc. the total cost to society is lower - this is why rebates are offered. But then there are major illnesses and the like, which increase cost to society - so those should carry larger costs.
Admittedly there are details that are probably important, but the major idea is sound - it encourages both minimal levels of treatment and preventive care but also (fairly) puts higher costs on those who need greater amount of care. This "greater cost" should probably be on some kind of relative scale; chronic illnesses with treatments should have not have debilitating payments (think of future value of work). Probably something like cost is inversely proportional to amount of time remaining to the average lifespan or something. Or so that "chronic" treatments are just a small amount per month, but a major illness at age 68 would cost more than the same illness at age 28 or 38. The costs should really be structured to reflect the cost/benefit to society rather than simply spreading high costs for a few to a small amount of people (in other words, avoid the "car payment" situation where yes, the monthly payments are lower but the total cost is higher. This is the sad economic effect of the current health care system; individual payments may be lower but the total cost to society is higher.)
To summarize:
1. Minimum fee required by all.
2. Rebates for routine checkups and basic preventive care that would fully offset the minimum fee.
3. Additional fees for any additional treatment beyond preventive/basic care ("basic" here things like non-STD communicable diseases or non-lifestyle-related injuries) to discourage unnecessary treatment and overly-risky behavior (e.g., X-games participants would pay for injuries or take out additional "occupational/hobby injury" insurance) but structured in a way to not financially crush people who need it.
4. Provide some mechanism to reduce facility costs - property tax breaks or something. After all, we provide public libraries but not public clinics?
5. Reduction in certification requirements for basic health services to increase the available health care providers to help with supply side. Things like nurse practitioners are a step in the right direction.
I'm sure there are other minutiae, but this framework should address many of the personal-cost-side issues related to health care.
"There are a dozen opinions on a matter until you know the truth. Then there is only one." - CS Lewis (paraprhase)
The original article is the commencement speech at Stanford’s School of Medicine. It gives a bird's eye philosophical perspective on the state of the medical profession. As such, I like it.
What I don't like are the people here trying to derive a political message from it. Health care in the US is so much less cost-efficient than the other industrialized countries, countries that have equivalent or better health care and that face the same challenges. This discussion sounds like looking for excuses not to fix the broken health care system.
"Why The Face" is this on Slashdot?
The ONLY reason healthcare costs are spiraling out of control is because we have now had more than 100 years of practicing fascism in the field.
Read this before modding me troll.
Instead of blabbing, how about helping consumers find the least expensive local provider of medications and lab tests? Why isnt there a SINGLE mobile app that works like "red laser" on the iphone for health care? I want to pull up the app and have it show me a list of drug stores and laboratories in my area. I want it to list the prices of the medications or lab tests I need. Why cant web 2.0 do this? And easily let me add my data as well?
they profit from the taking of organs, be damned about the ethics or the consequences
the reason that there is no legal market for human organs is the the fact that the poor will sell their kidneys. there is a belief in human dignity, i don't know if you share it, and anyone ethical does not believe that poverty should be a gateway to permanent degradation of health, of loss of dignity. being poor does not mean you have no human dignity
of course, people will still sell their kidneys, on the black market. there's nothing that can be done if someone is hell bent on ignoring their human dignity
but that doesn't mean that anyone with ethics is going to accept the fact that some people have no dignity, and that some businessmen recognize no human dignity. accepting these thoughts is a gateway to a hell of social darwinism, where human life and human dignity has no value
you may have no problem with that, but i do, and plenty others with a belief in human dignity do as well. so, stay in the shadows with your black market with your fellow sociopaths, and understand that just because you convinced someone to degrade their dignity, and you yourself recognize no dignity, does not mean that human dignity does not exist, and that it is not important for most of us
take solace in the fact that you should do well in business, where sociopathology is rewarded
as if doing well in business is the ultimate determinant of what is right and wrong. as so many callous ayn rand fools currently believe in this world, unfortunately
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
just like Soviet statistics was. The whole institution of state-operated statistics in Communist countries serves to prove the superiority of Communism/Socialism/Marxism/-ism. There is no other statistics, and no independent verification. As a matter of politics, WHO uses the data that states provide, without criticism.
The concept of "voluntary" in these countries is laughable. When everything you and your family get comes from the state, you "volunteer" to do whatever the state wants you to do. Your argument about "retention rate" of doctors allowed abroad would be laughable if it were not so sad. Just as in the Soviet union, family members of those allowed out the country must stay behind, and will suffer the consequences if the traveling family member does not return. This is Socialism 101 -- anyone who knows anything about it knows this.
You know, it is so sad to finally leave a Communist country (USSR, in my case), and then find uninformed cheerleaders for it here :-(
people who comment unfavorably on Communist countries after a visit there are simply not allowed back in. The secret police keeps track of what gets published, and keeps tabs on any notable foreigner (his/her guides are typically debriefed, too).
This is why most Sovietologists whose careers depended on being able to interact with the Soviet government were not critical of the Soviet economy, health care, etc -- they'd see major career setbacks otherwise. This is also how favorable scholarly opinions about the strength of Soviet economy were formed, and why its collapse was such a surprise.
The billing system is like dishonest car sales / repair.
With no or way off listed prices + lots of hidden fees / junk fees that few people know what they even are for.
lot's of 3rd party billing that goes to 1st and 2st party and if someone messes up they bill you even if some other party payed / covered that under a different fee.
over and double billing when fixing a car you don't get to bill the full labor cost of replaing 2 parts that are right next to each other when both need to be repaced at the same time.
Billing for stuff that happened mouths ago that was no billed at first but came form a 4rd party that took that long to work thought party's 1,2,3.
AND WHY IS THIS CARP TIED TO YOUR JOB????????????
That chart shows how people spend money with their own personal spending. It doesn't mention how much money is spent by governments, businesses, and insurers on health care. Medicaid and Medicare run at about a sixth of our federal budget, IIRC. You shouldn't use personal spending alone to gauge the impact that health spending is having on the economy.
Libertarians somehow believe that private businesses should be stronger than governments but weaker than individuals.
because we DO need more regulation. the 2008 market crash proves this: the fruits of years of deregulation in the financial world resulted in that (this is where you chirp in with your insane alternative reality explanation of why and how regulations resulted in the 2008 crash)
if you don't understand why healthcare needs regulation, you're truly insane
and enough with the commingling of government and corporations in your mind. if you reduce government, corporations take over in the power vacuum, commit every injustice you see a corporation corrupted government do, AND THEN SOME MORE INJUSTICES. what you do is you REDUCE the corrrupting influence of corporations in government. you certainly don't destroy the only thing you have protecting you from the abuse of corporations!
FIX government don't DESTORY it, libertarian morons
if your roof is infected with termites, is the solution to remove the roof from your house? no, the solution is to get rid of the termites! corporations are your enemy, NOT the government. without understanding this obvious fact, there is no understanding possible with you at all, because you are clearly insane if you believe your government, the only agent you have in the fight against corporations, is the enemy instead. INSANE
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
The productive people (those who can afford health insurance) are rightly concerned about facing this choice. Right now, they get the good doctor.
To be blunt and mighty cold, it is not economicly sensible to waste good doctors on the unproductive people. The care standards of a century ago would be sensible; they'd get no worse than my great grandparents had.
We simply can't provide everybody with the very best, in healthcare or anything else. (think "housing" or "food" if you like) Allowing a lottery to decide who gets the best care is worse than allowing money to decide who gets the best care.
Imagine if we handed out mansions by lottery, perhaps with a waiting list. Shelter is a human right, and everybody deserves the best! Just as in healthcare, the country would go broke trying and/or the waiting list would grow as required to ensure that most people die on the waiting list.
Right now, better health care is a mighty big incentive to work harder. People seek jobs that provide insurance and/or jobs that pay enough to make insurance affordable. People are lazy and selfish; they won't work simply for the common good.
Okay, I'll bite.
A friend with breast cancer recently flew from Canada to the Bahamas with a stopover in California where she was scheduled for a PET scan. The scan revealed a pleural effusion, fluid between the lung sac and chest wall. Her oncologist stated she should not fly again until the fluid was drained. The procedure, a thoracentesis or pleural tap is simple, ordinarily performed in the physician's examining room. My friend has excellent private health insurance and the insurer immediately assigned a case number to the incident. So far so good.
No physician would see us. The universal response was "we don't take walk-ins."
We decided to try face-to-face communication, and visited a large pulmonary practice. "We don't accept walk-ins" the receptionist explained. I replied, "I completely understand. I was a First Responder for 18 years, and every time I left a warm bed at 2 a.m. to help a stranger I knew I was putting my personal assets on the line. I always delivered the department lecture on liability. So I totally get it. Do you mind if we rest a few minutes before returning to the car?"
A few minutes later we were told that Dr. H. would see us. Said he has performed pleural taps countless times in his office. He would charge $100, or for a Canadian visitor would even do it for free, but no longer keeps the necessary tray on hand. Everything is now done in the hospital, where the procedure with tests and overnight stay will cost $30,000 - $40,000.
I telephoned the imaging center where the PET scan had been performed the previous day to ask if their invasive radiologist would perform a thoracentesis; my friend was an established patient there, not a "walk-in." He demurred but stated the condition was life-threatening and advised an immediate trip to ER.
Her PET was loaded on my laptop and we breezed through triage in two minutes flat. However, the thoracentesis was delayed by a mass casualty incident and she was given a room for the night. Hospital wanted to perform a PET scan even though we had the CD and written report from the previous day; finally common sense prevailed.
The following day she was brought to an examining room where a very young physician, still in his bicycle clothes and helmet, entered and introduced himself, drained 1.5 liters of fluid, applied a bandaid, and bade us farewell. A fifteen minute procedure.
Cost in any ER in Canada: $75. Cost in California: we're guessing $20,000. The hospital can sort it out with the insurers and we'll pick up the co-pay.
The experience has forever changed my view on the reasons for runaway health care costs in the U.S.A.
While it's too bad there aren't more medical schools in the U.S., fortunately there are other countries that are eager to set up medical schools, and ones set up to serve the overflow from the U.S. can be found dotted throughout the Caribbean and now Central American as well. Yes, people criticize them as being for people who couldn't get into an American school, and to some extent that's true, but there are some gems down there, like Ross University in Dominica or St. George's University in Grenada. In any event, graduates of foreign medical schools who want to practice in the U.S. must pass the U.S. Medical Licensing Exams, so it's not like it's a route through which dummies can become doctors.
For those who don't mind going further afield, Soochow University in China has an affordable English-language MD program. I'm sure there are many others.
Space game using normal deck of cards: http://BattleCards.org
No, in fact, it's not.
The bottom 50% of the population accounts for something in the order 3% of the health costs, while the top 5% account for about 49% (US government data). The bulk of people who are partaking of this "buffet" don't really cost a lot to cover; the seriously sick few are vastly more expensive. Imposing the high-deductible nonsense has the most effect on that 50% of the population who uses 3% of the healthcare. Yeah, that's gonna help a lot.
The other thing you are missing (and other people who make your argument) is that the incidence and cost of expensive health episodes is reduced by preventive care. Allowing people to go to the doctor today for cheap means that more potentially serious health conditions are detected early and managed for less cost. This is why detractors' typical analogies to car insurance are misguided: a car insurer that paid for your gas would be making it more likely that you'd have an accident (by incentivizing you to drive more). A health insurer that pays for your routine visits is making it less likely that you'll have a major health episode.
Are you adequate?
Another solution that seems to be coming due to need is the use of Physician Assistants in place of doctors. PA's have to be overseen by doctors but you can arguably have good health care for many people by combining many PA's under one doctor to see numerous patients. In many rural areas, this is becoming the norm and is good financially when dealing with everyday ailments.
Software and hardware engineers don't go around making excuses for the high cost of computers. They just lower them. The cost of computers has been reduced from $600,000 to $600 and the speed has been increased by 16 Million Times since 1950. On top of that, that's funny money. If you look at it in terms of real money, the cost of a computer has dropped from 20,000 ounces of gold to about 0.5 ounces.
When technology gets better, the cost of services should come down. The problem with health care is that the government has so much involvement with it. Instead of health care prices dropping, like they should be, for standard procedures they are rising. If you look at plastic surgery and lasik, two non government subsidized procedures, you'll see that they've come down dramatically in price just in the last 10 years.
Get rid of the HMO, Medicare, Medicaid, government regulations on what insurance companies must sell, The Prescription Drug Program. the AMA, licensure laws which politicize who may or may not be a doctor and do little to ensure quality of care. These are all government imposed monopolies or oligopolies Get the government out of education so that it doesn't cost half a working career salary just to get a medical degree.
"There is no industry in the world with 13,600 different service lines to deliver"
I don't just call BS. I propose that we consider IT as an example. How many 'different service lines' are there in just Windows server management? If by 'service lines' you mean 'functional tasks', well I still think 13,600 is an awful lot.
Consider Orthopedics. Is setting a left femur a seperate line of service from setting a right femur? How about setting an ulnar? Tibia? I suspect the number of 'service lines' in Orthopedics could be as many as a hundred, if you're creative.
As a general practitioner? Is the 'service line' of diagnosis of a common cold significantly different and worthy of differentiation from diagnosing, say, influenza? Bronchitis or pneumonia? Different findings, but very similar effort and knowledge. In fact, differential diagnosis relies on this step-by-step process, of which many steps are common.
The whole concept that medicine in the U.S. is more expensive than it need be because of the complexity of so many 'service lines' ignores the reality that, for the industrialized world, diagnoses are largely identical. Most of these nations find and treat the same illnesses, though perhaps in different proportions or severities.
All this time I thought American healthcare was expensive because we were obese, sedentary, and dependent on drugs. Now I find out we just know too much.
No, that's BS. We pay more for our healthcare first because it is unnecessarily complex - doctors perform tests intended to protect them from lawsuits far too often. And patients demand treatments and medications that are either marginally effective or just more expensive than necessary.
I lowered my overall cholsterol level from 238 to 197 in a year by diet modification alone. I am 56, and take no prescribed drugs. Oh, wait, I'm using my asthma meds PRN to deal with an allergic reaction, first time in 3 years. I could be taking arthritis drugs, any of several meds for asthma prevention (I have attacks every few years), meds for sinusitis/allergic rhinitis, etc. I exercise, so my blood pressure is not an issue, and I haven't have the expensive cardiac work done to see if my heart has anything previously undetected going wrong. And I could still keel over from a heart attack despite all the diangostics available. You cannot tell everything after all.
Admittedly, my wife has not been so fortunate. Four years ago, total knee replacement. Who knew a new knee joint costs $20,000? How much of that for insurance for the manufacturer? How much for R&D? How much R&D to avoid lawsuits? Three years ago, microfracture surgery on the other knee (auto accident 25 yrs ago made both pretty mangled) which has been completely successful. Less expensive than a replacement. Last year, removed a cancerous kidney. Not cheap. Found that 'accidentally' when diagnosing what was thought to be a gall bladder problem, pain in the abdmominal area usually associated with gallstones. Lucky. Expensive. Follow-up has been almost 50% of the cost of the surgery, but we're fairly confident there is no other cancer. So my wife has cost $86,000 is healthcare the past four years. I look this up. That's more than I've cost my entire life. I've spend 9 days in the hospital my entire life outside of the nursery after birth, and most of that was simple overnight+ for a viral thing and two surgeries - appendectomy in 1959 and cyst removal in 1966. I'm relatively cheap, including the fractured fibula in 1979.
I'm a little disappointed at the costs associated with ER visits, but here in AZ we have so many people without insurance and private physicians can't get reimbursed for charity care like hospitals do (yes, they do), so people are driven to the ER. It could be more cost-effective for the indigent and uninsured to get subsidies and stay out of the ER.
Let's not get into the illegal aliens that crowd the ER. They need care, and we must care for them. Then we need to send them w
deleting the extra space after periods so i can stay relevant, yeah.
And those people end up paying more in the long run? I don't have a problem with that. Unless of course you ask me to foot the bill for their lack of maintenance.
...which is the point. Providing a reasonable standard of health care to all individuals in a society provides huge benefits to the functioning, productivity, and quality of life of the society as a whole, and as a society we're going to face significant costs for 'lack of maintenance' or 'bad luck' or any other given issue that leads to serious health difficulties for an individual who lacks the means to pay. The assumption that we can reduce the costs to society as a whole by letting individuals get substandard care is false even from a purely economic perspective, backed up by a great deal of epidemiological and social science research.
So, ideally, we need a rational healthcare system which decouples healthcare decisions from monetary incentives and relies on healthcare providers to make reasonable decisions about treatment that maximize the overall benefit to society.
This was effectively SOP for the health care industry in the USA until relatively recently. I have half a dozen MDs in my family near/past retirement age, and they have stated that the expectation in the field of medicine was that between 10% and 30% of patients would simply be unable to pay for treatment, and that providing a reasonable standard of treatment for them regardless was simply the cost of doing business.
Coming out of medical school today with hundreds of thousands of dollars in debt and with the range/cost of treatments skyrocketing, medical students today don't have this option. This has also contributed to a legion of other perverse economic incentives, such as clinics which make money from the tests they recommend, and the transitive nature of health care coverage has given insurance companies solid financial reasons to deny coverage to the greatest degree possible, so the greatest amount of the cost is distributed elsewhere. The prime motivator for the increase in health care costs isn't the cost of the treatments available, it's coupling treatment decisions with monetary incentives that are inherent in the structure of our current system.
Health care can best be envisioned as a public utility. It's in our own interest to structure it in a way that provides the best quality of care available at a price we can pay.
So, SOMEONE has to determine which treatments are actually beneficial and cost-effective for patients. The best group to do this is medical professionals who get a steady paycheck and are judged on the quality of the health outcomes of their patients.
This means SOMEONE has to provide the steady paycheck, as well as provide metrics on the quality of work done, enforce professional standards, and generally keep a lid on things. Any structure capable of doing that society-wide is going to end up being functionally equivalent to a government. Attempting to do it on a smaller scale leads to massive structural inefficiencies as other health-care entities that are running for profit do their best to chuck 'unprofitable' patients/treatments out of their coverage areas and 'cherry-pick' profitable individuals.
Any plan that significantly disagrees with these core ideas is likely to be based on political posturing or willful ignorance... which is precisely the problem we're running into.
"We have to go forth and crush every world view that doesn't believe in tolerance and free speech." - David Brin
So, if a person is involved in an accident and needs $100,000 of critical care or they'll die, however with the care they are likely to nearly fully recover and live a high quality life for many decades, we spend the money. It is worth it.
Suppose the person is a criminal. Their mere existance is a loss to society. (they sell cocaine, or they are a mafia enforcer, or they rob people at gunpoint, or they rape little boys...)
Suppose the person is very useful. They are expected to provide millions of dollars of value to society. We could spend much more to ensure they get a better outcome. The bare minimum $100,000 isn't appropriate; we could spend $millions on the valuable person.
Okay, this isn't exactly the most serious piece I've ever written...
Women don't need them unless they fuck guys with warts.
Suggestion: don't fuck guys with warts
You'd be subjecting productive people to the standard of care that we can afford to give everybody, but the productive people deserve better.
Productive: that guy running SpaceX
Unproductive: car thief
"There is no industry in the world with 13,600 different service lines to deliver"
How about the software industry? There are plenty of programs out there today and they're delivered in a cost effective manner. If he wants to claim every variation of the same drug as a new service, then every software revision can be used in the same fashion.
Having people choose insurance unrelated to their employer obviously solves that issue, as would paying out of pocket.
Either way though, without or without the stupid employer-provided plans, people are encouraged to work harder. When personal desires like healthcare are provided for free, people give in to their lazyness more.
Did you even bother to read the text you quoted? How about we provide the "unproductive" people with crappy third-rate care?
I don't see how to do that, with or without ignoring the political impossibility.
We license doctors. This means yes/no. It's a boolean value. All doctors within a specialty are considered equal to each other. They are interchangable.
We don't assign ratings. I can't imagine actually having some system where your healthcare plan specifies a maximum doctor rating for you to use. There would be outrage.
Maybe it's just me, but perhaps if doctors began acting professionally, there might be some kind of improvement.
Where I work, there's frequent interaction with doctors. I'm tired of watching my co-workers get torn new assholes by doctors every other day. It's gotten to the point where I'm not sure I can trust any doctor here in down anymore given the threats they've dished out. There was even a case where they flat-out violated HIPAA to get a co-worker fired.
There's a good lesson to learn from doctors. Don't talk to your doctor when contracts are up for negotiation or you'll get fired!
It's not right. It's simply not right to say that doctors are the problem, but we need medical professionals, not abusive prima donnas who lose their shit every five minutes. Why do mistakes happen? Because no one wants to get their head torn off and possibly fired for telling a doctor he's wrong.
At least there's a telephone wire between us and the doctors. What about the nurses who have to be hospitalized after being violently assaulted by doctors? Excuse me, but I think if I were to go crazy and start beating one of my co-workers, I'd be in jail. Apparently if you're a doctor, it's your right to free speech.
I'm not making any of this up, which is why I'm not posting as anonymous. Someone needs to say something. Thank you.
Join the Slashcott! Stay away entirely Feb 10 thru Feb 17! Close all tabs to prevent autorefresh!
"Just put some 'tussin on it!" - Chris Rock
Harrison's Postulate - "For every action there is an equal and opposite criticism"
Here are some related ideas. Herbert Shelton advocated whole foods, fasting, and sunbathing, and was attacked by the medical community for it almost a century ago. His bio:
http://www.soilandhealth.org/02/0201hyglibcat/020127shelton.III/020127.toc.htm
And writings:
http://www.soilandhealth.org/02/0201hyglibcat/020127shelton.III/020127.toc.htm
More recent advocates of similar things:
Whole foods (and some fasting):
http://www.drfuhrman.com/
Whole foods (but maybe too whole grain heavy):
http://www.drweil.com/
Sunlight (as in curing vitamin D3 deficiency):
http://www.vitamindcouncil.org/treatment.shtml
An approach towards promoting moderate exercise and good eating by promoting physical infrastructure in our communities:
http://www.bluezones.com/makeover-about
Psychological health, to combat depression and promote healthy transformation:
http://books.google.com/books?id=bCuC2H-6k_8C
http://books.google.com/books?id=RKZreNYKNHQC
Economic health:
http://en.wikipedia.org/wiki/Jobless_recovery#Four_long-term_heterodox_alternatives
The big problem is simply that real cures (or preventatives) are inexpensive (sunlight, fasting, whole foods) for most expensive diseases of industrialized countries like cancer, hearth disease, and diabetes. The big profits are just in life long treatments, so no one pushes everyone to eat right, exercise, build community infrastructure, etc. And the medical insurance system is not set up to pay for people to live in healthy places, eat well (perhaps with a personal chef buying organic foods), have a better economic system with less stress for most people, etc.
Related recent discussion I was involved in on Slashdot:
http://slashdot.org/comments.pl?sid=1691318&cid=32642764
There are solutions. The biggest problem is, as you imply, social, not technical.
With that said, modern medicine and better sanitation and infrastructure as we now enjoy can treat or prevent a lot of things that were big issues in the past (accidents, infectious diseases). So, there have been improvements. But going forward, we really need to go back to the basics again.
A 21st century issue: the irony of technologies of abundance in the hands of those still thinking in terms of scarcity.
"This leads to people avoiding preventive care, which drives up costs in the long run."
No, you are wrong. As it turns out, preventative care - on average - does not lower cost. So says the NEJM "Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."
http://content.nejm.org/cgi/content/full/358/7/661
46 & 2
Most of all is people who don't oversimplify things by anthromorphicizing everything. The health care system isn't a person, it doesn't want or need anything. The people who make it up, on the other hand, are a very diverse group who have diverse and often conflicting needs and desires. If I'm a patient, cheaper healthcare is probably much more important to me than if I'm a doctor. We need to start taking into account the reality that there's no reform that isn't going to make some better off and others worse off.
In the 1800s there were 400+ medical schools in the united states. By the early twentieth century there were less than eighty.
You're referring to the big medical education reforms that occurred in the early part of the 20th century. Most of those pre-reform "medical schools" did little more than help their students cram for state medical exams. What put them out of business was not some arbitrary AMA quota, but the fact that getting actual clinical experience became a mandatory part of medical education.
In any case, the "shortage" your conspiracy theory posits (sounds like something Glen Beck would talk about) would have been well in place by 1950. And in 1950, medical care was still relatively cheap. It's only since then that prices have gone through the roof.
Finally, you're assuming that greedy doctors account for most of medical costs. Wrong. It's mostly drug costs, device costs, hospital costs (and I think you'll find that few hospital employees make a lot of money), etc.
I can't get insurance, and I need a hearing aid. I needed to get examined by an MD, who also dealt with the wax buildup in my ears. Cost: $200. Next I have to see an audiologist and get a hearing test, which will cost another $100-200. Finally the hearing aid itself will cost at least $1500. Sorry, no greed here, just an excess of expensive technology.
Don't allow the drug companies to own the FDA.
Break the drug companies hand-in-glove relationship with health insurance providers.
Fix the FDA so drug companies can only market actual cures, not yet more temporary symptom suppressants.
Review and fix all drug companies and health service providers pricing to be in line with all other countries.
I got diagnosed 3 weeks ago with submandibular cancer. So far I have had an ultrasound, a FNA biopsy, a CT, MRI and PET scan, CXR and a swag of blood tests. I was referred to the States, (if not the countries) best Cancer Hospital and I go into hospital tomorrow to have it cut out by a surgeon in the Head and Neck team at Peter MacCallum Hospital. As far as I know, I am receiving the best treatment possible for my condition, (I have some idea as I was an ICU nurse before changing to IT). For almost every appointment and test, all I do is give them my Medicare card and it is free. I paid for the MRI because there was a 10 day wait for a MRI at Peter Mac and I wanted to get into surgery as quickly as possible, but full fee paying, the MRI cost only $350, with contrast.
The healthcare in Australia is not quite as good as US healthcare, but we don't pay the huge premium for bleeding edge (no pun intended!) health care. I think there are significant differences in wages for Doctors and Nurses between countries, (our nurses are quite badly paid), and we aren't quite so litigious. Apart from that I am not sure why there is such a huge difference in price.
I have racked up quite a lot of medical costs in the last 2 months, and to be only out of pocket $350 I think is pretty neat.
My ex-employer is self-insured (They use a billing specialist, medical uses get sent to the billing specialist, who gets paid a flat rate per employee plus actual billings, however I do not know what this rate is). I live in the southern US.
Your best method of reducing your health plan costs is to have an enormous install base (>100,000 employees) and get providers to kick in for health initiatives (fill out personal information such as work out history, get a $25 credit, join the company gym and attend a certain number of fitness classes, get the gym membership for free, sign a no smoking pledge, get a credit type deal). Unhealthy employees pay considerably more, however health care is an opt-in (all employees are eligible, but if you do not want the company plan you are not required to receive it...generally the only people who choose not to get it are those who have other plans through spouses).
"We can choose what companies we want to do business with."
you are a clueless naive moron. ever hear of a MONOPOLY you idiot? what is the only entity that keeps corporations from becoming monopolies?
i'll give you a hint retard: it starts with "g" and ends in "overnment"
seriously you free market fundamentalists are FUCKING MORONS. you would be hilarious if there weren't so many of you clueless assholes hellbent on destroying this great country with your STUPID INSANE NONSENSE
your ideology is a form of naive gullible wish fulfillment fantasy that is ignorant of history and common fucking sense. seriously
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
What happened here guys? Prior to the health care reform bill passing, I could have sworn that slashdot was the favorite forum for Fox News consumers. Todays thread actually seems moderated in favor of public health care! (Which I support).
I suppose since Fox stopped talking about health care 24/7 that the sheep have lost interest in the subject?
I live in a country where we have a publicly funded health care system. There are no death panels. When I get asked about pre-existing health problems it's for a doctor to better treat me. Not to deny treatment or insurance payout.
When I get asked about race, nationality, it's to better cater to your cultural needs. You won't be tested for your wealth.
Treatment here is based on need and need alone. Not on ability to pay / socio-economic caste.
Of course there are limited resources and distribution issue, and somehow inequality still emerges (Inevitably, a capatilist demorcracy does not suffer the under class it creates) and you will go on a waiting list if you have non-urgent surgery. But thankfully this is assesed on medical need first and foremost, not on whether you're worthwhile saving.
The providers of medical care in America are blessed with an oversupply of diagonese and treatments compared to 1910 when doctors could do little but give you snake oil and suggest bed rest. Of course, to make more and more money they have invent new ways to provide more service and treat more agressively. In litigious America better for Doctors to over diagonose and over prescribe, with to a false dubios positive being better than a lawsuit spawning false negative.
In turn the insurance companies need to make more and more profit, charging it's customer base more and paying out less. A route to record profit is denying treatment at every excuse.
Who gets the squeeze here? It's the very people who the healthcare system was intended to treat.
I recall reading that the actual all up cost of hospital bed for a night in the US is as much as six times that of other countries.
When you shine a light on America's health system from the point of view of any other developed nations health system it looks very very bad.
But here's the death blow to private health care model: We still have private health care insurance and private practices and private hospitals in my country.
Yep it co-exists nicely with a publicly funded baseline system.
The old quote is that with tax you buy civilisation. I've often said tax is kind of enforced insurance on civilisation. It spreads the cost of maintaining civilisation accross the population, like an insurance policy spreads bankrupting life saving surgery of one individual accross all policy holders.
The only way to fix healthcare in America is a gradually introduced public healthcare system at least for urgent & emergency care, with elective and first instance care through insurance and private practice.
After logging in slashdot still does not take you back to the page you were on. It's been that way for 20 years.
They have more than a LPN or an RN...but not at the full power of a doctor. (And yes, they can proscribe some medication - but then again, some RN's can do that as well)
Sure the OB will tell you what they charge, and maybe some of the other docs involved. The hospital has no interest in doing so. The best I could do last time my wife and I had a baby (less then 2 years ago) was people with insurance usually pay in this range.
I asked the genuine midwives (non-hospital) and got answers. Last I checked, it was about $2500 to $3500 for the very best. That gets you a midwife with 20 to 25 years of experience, an assistant/substitute midwife with about 7 years of experience, and a helper to fetch things and clean messes. Such a team is capable of handling twins and breach births. Cheaper alternatives are probably available.
That covers everything: prenatal visits (you at their place), practice visit (so they can find your home), false alarms, a birth that could be lengthy, baby registration, and a couple post-birth visits.
Best of all, you're not treated like an item on an assembly line. You get to be informed and you have no trouble being in control. Nobody has a financial incentive to perform extra procedures that could hurt the baby or the mother. Nobody is eager and willing to force the birth (induction/episiotomy/caesarean) in order to get home early. Nobody will use scare tactics to control you. The germs are the ones your body faces everyday at home and would be bringing to a hospital if you went; there won't be any extra-special exotic germs that your immune system hasn't seen before. There aren't any cables or tubes attached to discourage you from moving about while increasing the risk of infection. Things don't go BEEP all night long, unless your home is normally like that. You get the food you like, unlimited visitors, your own comfy bed, and control over the thermostat. You can turn off the lights. You can birth in the best position (usually squatting or crawling) rather than the position that fits standard hospital equipment and doctor expediance.
"the sort of regulation that allows a health insurance company to make an obscene profit by closing out competition"
regulations didn't do this. GREED did this. how the FUCK do you blame lack of adequate regulations instead of SIMPLE HUMAN GREED?
what we have now, case #1: shoddy poor quality regulations -> obscene profits, closing out competition
what you want, case #2: less government, less regulations, less enforcement -> MORE obscene profits, monopolization, MORE corruption of remaining cauterized rump of a tiny government
what should happen, case #3: MORE regulations, of HIGHER quality -> SMALLER corporate profiteering on people seeking healthcare, MORE competition
WITHOUT regulations, companies naturally gravitate towards oligopoly. monopoly. i DO hope you see this simple obvious truth, right?
say a bank was robbed because the doors were left open. a sane person would make sure a policy was put in place to make sure the doors are locked every night, and go after the thieves (aka: introduce more, higher quality regulations, and go after the REAL PERPETRATORS). but a libertarian/ free market fundamentalist/ tea party moron meanwhile would say:
1. forget about the thieves ...morons)
2. the problem is the bank's regulations! (you mean LACK OF regulations/ SHODDY POOR QUALITY regulations!)
3. finally, the solution is: completely remove the doors from the bank! (less government! yay!
"maybe the answer is to have a small government"
then the power vacuum is filled by corporations. and they kick around the tiny government even more. do you know how corruption works?
"how many government employees do you actually really need?"
as many as it takes to adequately police the corporations. not more. not less. how many were needed to police bp before they let their oil well blow out? a hell of a lot more than they had before late april, that's for sure
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
"You think that free market principles and the idea of individual liberty..."
i stopped reading right there
yes: if you COMPLETELY CHANGE THE FUCKING SUBJECT MATTER then you can make me look like a total asshole by applying my observations to COMPLETELY FUCKING UNRELATED SUBJECT MATTER
i believe i was talking about regulating CORPORATIONS, no?
can you tell the difference between a CORPORATION and an INDIVIDUAL?
do you understand my observations are about CORPORATIONS?
do you agree with my observations about CORPORATIONS?
do you believe that CORPORATIONS deserve the same protections as an INDIVIDUAL?
no?
then apologize for going off on me like a spastic retard who can't keep track of the fucking subject matter, you histrionic twit
there is more than the threat of GOVERNMENTS to individual liberty. there is also the threat of CORPORATIONS to individual liberty. therefore in the name of individual liberty, support government regulation of CORPORATIONS
understand now you panicky fuckwit?
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Who is responsible for health care? At one time a doctor had a "consulting room". A physician doesn't give diagnoses on stone tablets as delivered from burning bushes and many physicians have their own quirks and favorite treatments. A patient should not be averse to challenging what he is told. The old bit about getting a second opionion should always be considered.
One huge failing of the U.S. health care industry has been the systematic of legislating away a patient's ability to treat himself. In the 70's; if you had conjunctivitis (pink eye) you went to the drug counter and purchased opthalmic grade silver nitrate solution and used the eye drops. Today you pay $175 to a physician after a several hour wait to write a prescription for opthalmic ointment that you pay $80 for and is simply opthalmic grade silver nitrate ointment. A patient is, today, considered too stupid to treat common maladies.
One solution would be to disconnect the health insurance industry from the health care industry. As long as "for profit" massive corporate hostpital chains are owned by "for profit" health insurance companies it is only in their interest to keep costs spiraling upward. This certainly seems to call for a Teddy Roosevelt mentality to correct. How about legislation to consider the collusion on costs between insurance and corporate providers to be a SEC conflict of interest violation?
Another solution is to remove some of the monopolistic controls of pharmaceutical grade drugs. i.e. Amoxillin at my local pharmacy costs $125 for 20 500mg tablets. I can purchase veterinary grade Amoxillin over the counter at the Ranch and Home store at a cost of $12.95 for 100 500mg tablets. The real kicker is the tablets are identical in marking and the coding on the packaging shows they are made by the same company from the same factory.
There has been a systematic mindset propagated since the inception of organizations like the AMA that all treatments HAVE to come from a licensed physician. And we have draconian legislation to force such dependence on physicians which is often not called for and crowds emergency rooms with routine cases.
I still laugh at the Obama "Health Care" bill that does nothing to address health care but seems to be a legally mandated sinecure to heal insurance companies.
NRRPT/RCT
i am glad you have a fucking bug up your ass about individual rights
but why don't you fucking apologize to me for complete misrepresenting my words, asshole
intellectual property law is philosophically incoherent. it is your moral duty to ignore it or sabotage it
Biggest reason for expense -- drug companies, law suites and manual records, and not necessarily in that order. An average physican earns 300k per year and has about 200k of insurance. Smile, who makes the money? Must be the insurance companies.
While I agree with the thesis you propose, your argument that the only feasible rating system would need to be "functionally equivalent to a government" seems flawed. Further, some sort official rating system on medical efficacy does not on it's own mandate insurance coverage, unless you were envisioning a single-payer system (which itself has flaws with dealing with innovation and varying desires of coverage). Moreover, you admit with political posturing or willful ignorance this won't work, but this is the current reality of our government.
While it's great to dream about health-care reform from the provider side, the change really needs to happen on the insurance side. I agree, as you eluded, that mandated minimum coverage for all would help lower provider costs. Implementing such a system, however, is still up for debate.
In contast, to lower insurers costs, one would need to define a minimum set of preemptive care, so that patients can easily float from one policy to another, without insurers having to worry about their previous lack of coverage. The most sensible way I can think of to do both would be provide vouchers that only work with mutual insurers. As the money would be pre-alloted for you, you wouldn't need to pay as high of a fee (like choosing to pay your car insurance all at once, instead of throughout the year) or be limited by your employers coverage options. Further, since your voucher will be with a mutual insurer, you'll potentially receive dividend pay back at the end of the year by choosing the most efficient plan for you. This would create a self regulating public, and provide insurance companies as well as patients incentives to access efficacy of care. On the flip side one would need to provide a finical penalty for not going to your preventative appointments (much like one would have a penalty for not changing the oil on a car under lease) in order to allow the public to easily upgrade or downgrade their level of coverage.